Provider Demographics
NPI:1588841688
Name:BLUM, RAYMOND N (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:N
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:#3650
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-831-4774
Mailing Address - Fax:303-839-7750
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:#3700
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-4774
Practice Address - Fax:303-839-7750
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263235Medicaid
CO26323OtherLICENSE
CO440000067OtherRAILROAD MEDICARE
COD24786Medicare UPIN
CO01263235Medicaid